PRE TRAINING QUESTIONNAIRE

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "PRE TRAINING QUESTIONNAIRE"

Transcription

1 PRE TRAINING QUESTIONNAIRE Wellbeing Martial Arts collects the information on this form to register and administer enrolments into programs run by Wellbeing Martial Arts. This information will not be disclosed except where required by law. The information may be used to send you information from Wellbeing Martial Arts. (Please sign where the X is displayed. An adult witness signature is required on pages 3 and 6) 1. Applicants Details Date / / Class Location First Name: Surname: Date of Birth: / / Gender: Address: Suburb: Postcode: Mobile: Home: Work : Address: Emergency Contact : Emergency Ph: 2. MARTIAL ARTS HISTORY Have you studied martial arts before? YES NO If yes please provide details: Style Grade Achieved: Number of years studied: Instructor: 3. EXCLUSION OF APPLICANT Have you ever been excluded from Martial Arts in the past by a medical practitioner or any other person or entity or a Martial Arts Club? YES If yes, provide details: NO Your main goal or goals in joining:- Fitness Stress Relief Confidence Self-defence Health Social Knowledge Other What classes are you initially enrolling in? Karate Tai Chi / Internal Kung Fu 1 P a g e

2 4. PRE-EXERCISE - MEDICAL SCREENING TOOL Please circle response 1. Has your doctor ever told you that you have a heart condition or have you ever Yes No suffered a stroke? 2. Do you experience unexplained pains in your chest at rest or during physical activity/exercise? Yes No 3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that Yes No causes you to lose balance? 4. Have you had an asthma attack requiring immediate medical attention at any time Yes No over the last 12 months? 5. If you have diabetes (type I or type II) have you had trouble controlling your blood Yes No glucose in the last 3 months? 6. Do you have any diagnosed muscle, bone or joint problems that you have been told Yes No could be made worse by participating in physical activity/exercise? 7. Do you have any other medical condition(s) that may make it dangerous for you to Yes No participate in physical activity/exercise? 8. Do you have a Family history of heart disease (eg: stroke, heart attack) Yes No 9. Do you smoke cigarettes on a daily or weekly basis or have you quit smoking in the last 6 months? 10. Have you been told that you have high blood pressure? Yes No 11. Have you been told that you have high cholesterol? Yes No 12. Have you been told that you have high blood sugar? Yes No 13. Have you spent time in hospital (including day admission) for any medical Yes No condition/illness/injury during the last 12 months? 14. Are you currently taking a prescribed medication(s) for any medical conditions(s)? Yes No 15. Are you pregnant or have you given birth within the last 12 months? Yes No 16. Do you have any muscle, bone or joint pain or soreness that is made worse by Yes No particular types of activity? 17. Are you currently taking any drugs that may impair your reaction time or judgement Yes No 18. Please list any allergic reactions, physical or medical limitations we should be aware of: Yes No Some medical conditions may require the provision of a medical certificate prior to training. I believe that to the best of my knowledge, all of the information I have supplied within this tool is correct. I recognise the instructor is not able to provide me with medical advice with regard to my physical fitness and that the information I have provided will be used as a guideline to the limitations of my ability to exercise and participate in martial arts training. X Signature Date 2 P a g e

3 CONDITIONS OF MEMBERSHIP I understand the risk of studying Martial Arts and on behalf of myself, my heirs, executors and administrators I hereby release Wellbeing Martial Arts and all instructors and other students of Wellbeing Martial Arts from any liabilities of any nature (including any costs, whether or not subject of a court order), for any type of injuries or loss sustained while training, studying, practicing or in the application of Martial Arts. I also state that I am in good physical condition and know of no reason why I cannot study and participate in Martial Arts or other activities organised by Wellbeing Martial Arts. I agree to be bound by the Wellbeing Martial Arts Code of Practice and rules I understand martial arts involves risk of serious injury I understand all fees are non-refundable I understand I should seek medical advice if I am in any doubt about my ability to train I agree that Wellbeing Martial Arts may take photographs and may make video and audio material of member s classes and other Wellbeing Martial Arts events and that these materials may be used for display, promotion and or advertising, or sold for profit, and the member hereby waives any compensation to which they may otherwise be entitled for appearing in such materials. Unavailability of facility or service:- I agree to accept the fact that a particular facility or service in the premises may be unavailable at any particular time due to a prior booking, mechanical breakdown, fire, act of God, condemnation, loss of lease, catastrophe, terrorist act or other reason. Hours of Operation:- Operations scheduled may vary and are subject to change from time to time. Lost/Stolen Items Wellbeing Martial Arts or its Instructors will not accept responsibility for any equipment that is lost or stolen at training venues. Management reserves the right to refuse entry, cancel a membership or request a member or casual exercise patron to leave the training venue if the person does not behave in a responsible manner, is under the influence of drug/alcohol or does not adhere to conditions of use. In the case of an emergency I hereby authorise any licenced medical personnel to perform any accepted medical procedures deemed necessary and agree to bear the expenses of any such treatment. I HAVE READ, AND UNDERSTOOD AND AGREE TO THE CONDITIONS ABOVE AND WOULD LIKE MYSELF AND OR MY CHILD OR CHILDREN TO BEGIN MARTIAL ARTS LESSONS. 5. DECLARATION OF UNDERSTANDING Martial Arts Is Dangerous I have read and understood the terms of the Martial Arts Contract or if I did not understand the terms of the Contract, I requested an independent person to explain them to me. Dated this day of 20 X Applicant Signature Guardian Consent is required if the applicant is under 18 years of age I hereby certify and decree that all the information contained in the declarations above is true and accurate X Guardian Signature Relationship to Applicant X Witness signature *Name of Witness (Print in Block Letters) 3 P a g e

4 WELLBEING MARTIAL ARTS Martial Arts Contract MARTIAL ARTS IS DANGEROUS The following conditions must be read carefully: 1. Interpretation "the Applicant" means the individual who signs this Contract and agrees to be bound by its terms and includes a guardian of that individual if the individual is less than 18 years of age. 2. Acceptance I, (full name of student) of (residential address) I, (full name of Guardian if the applicant is under 18) of (residential address of Guardian) the Applicant, hereby agrees to be bound by the terms of this Contract with Wellbeing Martial Arts and the persons named and described in Schedule 1, hereinafter jointly and severally referred to as "the providers". The providers agree to permit me to use their premises and facilities for Martial Arts, to instruct me in Martial Arts and related activities ("the service") upon and subject to the following terms and conditions: (a) Club Fees The Applicant will pay on demand the prescribed or stated fees for the service. Such fees may be notified to the Applicant by letter or memorandum or by notice displayed in the provider's premises or premises occupied by the provider or verbally. (b) Medical Conditions The Applicant warrants that he or she has not at any time suffered any blackout, seizure, convulsion, fainting or dizzy spells and is not presently receiving treatment for any illness, disorder or injury which would render it unsafe for the Applicant to take part in Martial Arts. The applicant further warrants that he/she has provided information on any and all pre- existing medical conditions. (c) Exclusion of Applicant The Applicant warrants that he or she has not at any time been excluded from Martial Arts by a medical practitioner or any person or entity including a Martial Arts Club. (d) Rights of a Consumer If the Competition and Consumer Act 2010 or similar state laws apply to this agreement then certain terms and rights may be implied into this contract which operate for the benefit of the Applicant. Under the provision of that legislation, those terms and rights, and any liability of the supplier flowing from them, cannot be excluded, restricted or modified by any provision of the contract. PLEASE NOTE THE FOLLOWING: If the Competition and Consumer Act 2010 or similar State laws operates so as to prevent the exclusion, restriction or modification of warranties otherwise implied by those laws then the liability of the offerer for breach of those warranties is limited to: (i) (ii) the re-supply of the Martial Arts instruction and related activities; or the payment of the cost of having the Martial Arts and related activities supplied again. 4 P a g e

5 (e) Waiver and Indemnity In all other cases and except where inconsistent with the above, the Applicant for him/herself, his/her executors, administrators, dependents and other personal representatives, hereby absolves and indemnifies the providers and all their servants, agents, employees and other students or persons under the providers control (the "indemnified") from all liability howsoever arising for injury or damage (including but not limited to the Applicants' person, whether fatal or otherwise, property and personal belongings) however caused including by the negligence of the indemnified, arising out of or participating in Martial Arts or in connection with Martial Arts or in any way caused by, or arising out of, any activity carried on by the indemnified. I, the Applicant, have been advised and understand that the practice of martial arts is potentially dangerous. I, the Applicant, agree to occupy and use the premises of the Wellbeing Martial Arts Academy at risk to myself and release to full extent permitted by law Geoffrey Jackson, The Wellbeing Martial Arts Academy, and its agents, servants, contractors and employees from all claims and demands of every kind in of or resulting from any accident or damage to property or injury or death to myself while undertaking training in martial arts with the Wellbeing Martial Arts Academy. (f) Martial Arts done at Applicant's own Risk Any person training Martial Arts, or in activities connected with Martial Arts or participating in any activity carried on by this Club/Academy Company are only allowed to do so on the distinct understanding that they do so entirely at their own risk. (g) Martial Arts not to be taught by Applicant The Applicant agrees that he/she is in no way qualified or authorized to teach Wellbeing Martial Arts publically or privately in any way whatsoever for personal, monetary or any form of gain whatsoever unless with the written authorization of Wellbeing Martial Arts. (h) Agreement to abide by the Academy Rules I, the Applicant, agree that I will abide by the Wellbeing Martial Arts Class Code of Conduct and agree and acknowledge that any failure to abide by rules of the Code of Conduct may result in my expulsion from the Academy. (i) Acceptance Performance of the provider's obligations under the contract may be effected by any one or more of the providers either jointly or severally. (j) Governing Law Any agreement entered into pursuant to this acceptance is to be governed by the laws of the State of Victoria and Australia the Courts of the Commonwealth of Australia shall have exclusive jurisdiction to entertain any action in respect of any such agreement. (k) Statement of Understanding I, the Applicant have read, or have had read to me the above conditions and having understood the same, I consent to the activities proposed. (l) Acknowledgment The Applicant acknowledges that he/she has had adequate time to read and review this Contract and signs this Contract without duress. X Signed (Applicant or guardian) This (date) day of (month) 20 X in the presence of (signature of witness) Name of Witness (please print in block letters) [This contract must be signed by a guardian of the applicant if the Applicant is under 18 years of age.] 5 P a g e

Bayou Wing Chun Waiver APPLICATION FORM

Bayou Wing Chun Waiver APPLICATION FORM Bayou Wing Chun Waiver APPLICATION FORM 1. APPLICANT'S DETAILS: Last Name:... Given Names:... Address:... Postcode:...Ph (home)...ph (work)...... Email:. Mobile-Phone: Occupation:...Date of Birth... Name

More information

Adults' + Teens' Martial Arts Classes! Welcome Pack

Adults' + Teens' Martial Arts Classes! Welcome Pack Hi there, Adults' + Teens' Martial Arts Classes! Welcome Pack Welcome to the Raining Spirit Dojo, a Modern, Eclectic Martial Art Dojo in Hurstbridge, Melbourne, where we study a beautiful, fundamental,

More information

A DIVISION OF SHAOLIN JEE SHIN WING CHUN KUNG FU

A DIVISION OF SHAOLIN JEE SHIN WING CHUN KUNG FU A DIVISION OF SHAOLIN JEE SHIN WING CHUN KUNG FU MEMBER APPLICATION FORM 1. APPLICANT S DETAILS: Surname: Given Names:.. Address:. Postcode:. Ph (home): Ph (mobile). Occupation:. Date of Birth:. Concession

More information

Wu Chi School of Arts

Wu Chi School of Arts Wu Chi School of Arts Welcome to Wu Chi School of Arts! We are excited to welcome you to our School and for you to get started on your journey into the world of Wu Chi Tao. If you have any queries or require

More information

I, Date of Birth../../ Home address... City/State/Country Contact address is Australia. Emergency contact name.. Emergency contact phone no...

I, Date of Birth../../ Home address... City/State/Country Contact address is Australia. Emergency contact name.. Emergency contact phone no... XTREME KITES & PADDLE PTY LTD PHONE: 0402 842 944 RELEASE AND WAIVER OF LIABILTY ASSUMPTION OF RISK AND IMDEMNITY AGREEMENT This is an important document which sets out your legal rights and obligations

More information

TERMS AND CONDITIONS OF MEMBERSHIP

TERMS AND CONDITIONS OF MEMBERSHIP TERMS AND CONDITIONS OF MEMBERSHIP THIS IS AN IMPORTANT DOCUMENT AND YOU SHOULD READ IT CAREFULLY BEFORE SIGNING IT. UPON SIGNING THIS MEMBERSHIP APPLICATION FORM AND LICENCE CARD, YOU ACKNOWLEDGE THAT

More information

USA Water Ski Event Sanction Agreement

USA Water Ski Event Sanction Agreement USA Water Ski Event Sanction Agreement This is a contract (the Agreement ) between USA Water Ski ( USA-WS: ), a New Jersey not-for-profit corporation, the event promoter(s) or director(s) and all other

More information

Alcatraz 2009 Preliminary Information Meeting: Saturday October 18, 2008 DC Ranch Village 6:00-7:00PM N. Thompson Peak Parkway, Scottsdale

Alcatraz 2009 Preliminary Information Meeting: Saturday October 18, 2008 DC Ranch Village 6:00-7:00PM N. Thompson Peak Parkway, Scottsdale Alcatraz 2009 Preliminary Information Meeting: Saturday October 18, 2008 DC Ranch Village 6:00-7:00PM 18501 N. Thompson Peak Parkway, Scottsdale Introduction/history of the event Description of the swims

More information

TERMS AND CONDITIONS OF THE AUSTRALIAN CRICKET FAMILY (ACF) AND ACF GOLD PRIORITY TICKET ACCESS PERIODS FOR THE 2017/18 PERTH ASHES TEST

TERMS AND CONDITIONS OF THE AUSTRALIAN CRICKET FAMILY (ACF) AND ACF GOLD PRIORITY TICKET ACCESS PERIODS FOR THE 2017/18 PERTH ASHES TEST TERMS AND CONDITIONS OF THE AUSTRALIAN CRICKET FAMILY (ACF) AND ACF GOLD PRIORITY TICKET ACCESS PERIODS FOR THE 2017/18 PERTH ASHES TEST In consideration of Cricket Australia granting you, as an Eligible

More information

USA RUGBY EVENT SANCTION AGREEMENT

USA RUGBY EVENT SANCTION AGREEMENT USA RUGBY EVENT SANCTION AGREEMENT This agreement, entered into and between USA Rugby and (name of Local Organizing Group/Club) shall be a part of the Sanction Agreement for the Event known as (name of

More information

2017 KOREA OPEN. Group Stunt Junior All Girl Level 3 GSJRAGL3 ICU Median (Level 3) 12 to 15 years Up to 5 female athletes

2017 KOREA OPEN. Group Stunt Junior All Girl Level 3 GSJRAGL3 ICU Median (Level 3) 12 to 15 years Up to 5 female athletes DIVISION Partner Stunt Divisions DIVISION CODE 2017 KOREA OPEN SKILL LEVEL / RULES AGE REQUIREMENT TEAM SIZE Partner Stunt Open Coed Level 4 PSOL4 ICU Advanced (Level 4) 12 years or older 1 male + 1 female

More information

Have fun while learning the basic skills, techniques and rules of golf. Beginners and Advanced Players ages 5-15

Have fun while learning the basic skills, techniques and rules of golf. Beginners and Advanced Players ages 5-15 Cedars Kids Club Have fun while learning the basic skills, techniques and rules of golf. Beginners and Advanced Players ages 5-15 Ages 10 & Under: Session 1: July 5 to July 31 Session 2: August 2 to August

More information

Red Deer Invitational November 25, Sanction #

Red Deer Invitational November 25, Sanction # Red Deer Invitational November 25, 2017 Sanction #2017-12 Venue: Hunting Hills High School 150 Lockwood Ave Weigh ins: Friday, November 24, 2017 7:30 9:00 PM To be considered for a Remote Weigh-In site,

More information

Fall play on TO FIT. SO KIDS CAN PLAY. Little Rock Athletic Club Little Rock Racquet Club

Fall play on TO FIT. SO KIDS CAN PLAY. Little Rock Athletic Club Little Rock Racquet Club ized TO FIT. SO KIDS CAN PLAY. Fall 2016 Now kids 12 and under can compete like the big kids because the smaller courts, slower balls and appropriate sized rackets let them learn fast. http://www.lrac.com/tennis/junior-academy

More information

45 East Boston Mills Road Boston Heights, OH (330)

45 East Boston Mills Road Boston Heights, OH (330) 45 East Boston Mills Road Boston Heights, OH 44236 (330) 650-4111 MATTHEWS-THOMAS PARK PAVILION POOL MEMBERSHIP SEASON: May 26, 2014 through September 1, 2014 MEMBERSHIP FEE RESIDENT NON-RESIDENT Senior

More information

S KYLINE J UNIORS V OLLEYBALL

S KYLINE J UNIORS V OLLEYBALL S KYLINE J UNIORS V OLLEYBALL 2014-2015 Player Information Athlete s Phone Number: Email Address: Weight: Date of Birth: Current School Attending: Previous Club Experience: Parent(s) or Guardian (Primary

More information

The Salford Charity Dragon Boat Festival 2015

The Salford Charity Dragon Boat Festival 2015 The Salford Charity Dragon Boat Festival 2015 Sunday 10th May 2015 - Salford Quays Team Captain: Festival Office: 01745 339003 info@sdbf.co.uk www.sdbf.co.uk Contents Other useful information Captain s

More information

Snorkeling BSA Certification

Snorkeling BSA Certification Snorkeling BSA Certification When: 7:00 AM Saturday, December 7 th Where: The Dive Shop 2714 Sandy Plains Rd, Marietta, GA 30066 Who: Anyone Swimming with the Manatees in January and not already certified

More information

JACK S DIVING LOCKER

JACK S DIVING LOCKER JACK S DIVING LOCKER JUNIOR CAMP REGISTRATION Camp: Start Date: Student s Name: Age: Birth Date: Address: Home Phone: Email: Mother s Name: Mother s Cell: Mother s Work Phone: Father s Name: Father s Cell:

More information

Youth Diving: Responsibility and Risks Flipchart. Welcome

Youth Diving: Responsibility and Risks Flipchart. Welcome Welcome Exploring the underwater world is both fun and serious. Scuba diving is enjoyed by millions of people all over the world. Scuba Diving requires: Some physical fitness Ability to solve problems

More information

The Bradford Lord Mayor's Appeal Dragon Boat Festival 2015

The Bradford Lord Mayor's Appeal Dragon Boat Festival 2015 The Bradford Lord Mayor's Appeal Dragon Boat Festival 2015 Saturday 09 May 2015 The River Aire, Roberts Park, Saltaire Will you join us to Race the Dragon for charity? Festival Office: 0845 293 0897 entries@lmabradforddbf.co.uk

More information

Lesson Program. Thanks again for choosing the Ft. Lauderdale Diving Team!

Lesson Program. Thanks again for choosing the Ft. Lauderdale Diving Team! Lesson Program Welcome to the Ft. Lauderdale Diving Team lesson program. We are pleased you have selected the Ft. Lauderdale Diving Team and we are confident you have chosen the right program. Students

More information

YOUR INVITED TO TRYOUT FOR TEAM IGLOO

YOUR INVITED TO TRYOUT FOR TEAM IGLOO YOUR INVITED TO TRYOUT FOR TEAM IGLOO Team Igloo Information Highlights 2 ELITE TRAVEL TEAMS 4th Grade Boys Team 5th Grade Boys Team EQUIPMENT AND COST HIGHLIGHTS 100% of the funds collected goes to purchase

More information

Tennis For Kids 2018 Coach Terms

Tennis For Kids 2018 Coach Terms Tennis For Kids 2018 Coach Terms You will have to complete the Application on the LTA website in full. Coaches who have previously successfully delivered a Tennis For Kids Programme may not have to go

More information

Karate Class Application School Year

Karate Class Application School Year Karate Class Application School Year 2017-18 Checklist Please bring this application with payment directly to the gym on the first day of karate class or the school office. For your information: The Karate

More information

STINGRAY ALLSTAR PREP REGISTRATION PACKET

STINGRAY ALLSTAR PREP REGISTRATION PACKET STINGRAY ALLSTAR PREP 2017-2018 REGISTRATION PACKET Allstar Prep Program: Congratulations on choosing to become a part of the biggest and most successful Allstar gym in the country! We are delighted to

More information

Matthews Thomas Park Pool Membership 6737 Olde Eight Rd Boston Heights, OH (330) Boston Heights Village Hall (330)

Matthews Thomas Park Pool Membership 6737 Olde Eight Rd Boston Heights, OH (330) Boston Heights Village Hall (330) Matthews Thomas Park Pool Membership 6737 Olde Eight Rd Boston Heights, OH 44236 (330) 655-5160 Boston Heights Village Hall (330) 650-4111 POOL OPERATING SEASON: SATURDAY, MAY 28, 2011 THROUGH SEPTEMBER

More information

2016 Iowa Governor s Cup Taekwondo Championships All American Sports Complex, Ames IA February 2016

2016 Iowa Governor s Cup Taekwondo Championships All American Sports Complex, Ames IA February 2016 2016 Iowa Governor s Cup Taekwondo Championships All American Sports Complex, Ames IA hamannma@hotmail.com February 2016 Dear Taekwondo Family, Greetings from Ames, Iowa and Iowa State University! We would

More information

Seasonal Hospitality Terms and Conditions 2015/16

Seasonal Hospitality Terms and Conditions 2015/16 Seasonal Hospitality Terms and Conditions 2015/16 INTRODUCTION The Seasonal Hospitality Terms and Conditions 2015/16 apply to the purchase and use of Facilities by Ticket Holders. Please read the terms

More information

RED RIDER RACING PROGRAM OFF-ROAD

RED RIDER RACING PROGRAM OFF-ROAD RED RIDER RACING PROGRAM OFF-ROAD Registration Deadline: June 1 st, 2017 Eligible Riders/Models: Anyone who has purchased and owns a registered Canadian Specification model 2015/2016/2017 CRF450R, CRF450RX,

More information

For such purposes, UEFA intends to organise a tendering process ( Tender ).

For such purposes, UEFA intends to organise a tendering process ( Tender ). Invitation to express interest Production Services for the European Club Football Season Kick-off Party 2018 1. Introduction UEFA wishes to select one company for the stage and content production services

More information

CLEVELAND INDIANS GROUP TICKET SALES AGREEMENT

CLEVELAND INDIANS GROUP TICKET SALES AGREEMENT CLEVELAND INDIANS GROUP TICKET SALES AGREEMENT This Cleveland Indians Group Ticket Sales Agreement (the Agreement ) is entered into between the purchaser of Cleveland Indians group tickets ( Group Tickets

More information

Parent/Guardian Signature: Date:

Parent/Guardian Signature: Date: Program Waiver: PARTICIPATION AGREEMENT, SWIMMING AND SKATING EQUIPMENT RENTAL AGREEMENT, RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISK BY SIGNING THIS DOCUMENT YOU ARE ENTERING INTO A

More information

JUNIOR LIFE SAVER OF THE YEAR 2010/11 Nomination Process & Program

JUNIOR LIFE SAVER OF THE YEAR 2010/11 Nomination Process & Program JUNIOR LIFE SAVER OF THE YEAR 2010/11 Nomination Process & Program The Director of Youth & Membership, Glenn Langley invites you to nominate your outstanding Under 14 club members for Surf Life Saving

More information

Panorama Football Club

Panorama Football Club MEMBER NO: AGE GROUP: MEMBER'S DETAILS ID NUMBER: HOME ADDRESS: DATE OF BIRTH: (DD/MM/YYYY) TEL (H): MOBILE: EMAIL: TEL (W): MEDICAL DETAILS (allergies or any other serious medical conditions) ALLERGIES:

More information

מועדון הכדורגל מכבי תל אביב חברת מכבי תל אביב כדורגל בע"מ

מועדון הכדורגל מכבי תל אביב חברת מכבי תל אביב כדורגל בעמ Stadium Regulations and Ticket Terms and Conditions Definitions "The Club" means Maccabi Tel Aviv Football Club. "Stadium" means Bloomfield Stadium and all locations owned, occupied and/or utilised by

More information

MARYLAND PROFESSIONAL KARATE ASSOCIATION, INC. YIN-CHUAN SCHOOL OF THE DRAGON 6707 HOLABIRD AVENUE BALTIMORE, MARYLAND TEL. NO.

MARYLAND PROFESSIONAL KARATE ASSOCIATION, INC. YIN-CHUAN SCHOOL OF THE DRAGON 6707 HOLABIRD AVENUE BALTIMORE, MARYLAND TEL. NO. MARYLAND PROFESSIONAL KARATE ASSOCIATION, INC. MEMBERSHIP APPLICATION NAME LAST FIRST DATE OF BIRTH HOME PHONE HOME ADDRESS STREET CITY STATE ZIPCODE EMPLOYED OCCUPATION BUSINESS PHONE STUDENT/SCHOOL SEX:

More information

2018 AUSTRALIAN NATIONAL CHAINSAW RACING TITLES. Tenterfield Show Grounds Friday 9th - 11th February

2018 AUSTRALIAN NATIONAL CHAINSAW RACING TITLES. Tenterfield Show Grounds Friday 9th - 11th February 2018 AUSTRALIAN NATIONAL CHAINSAW RACING TITLES Tenterfield Show Grounds Friday 9th - 11th February 2018 National Chainsaw Racing Titles Program Friday 9th February 8.00am start Briefing & draw - Cutters

More information

Welcome. Family Outdoor Day. on Saturday, June 1, 2013 at. Hunting Hills in Dilliner Pennsylvania!

Welcome. Family Outdoor Day. on Saturday, June 1, 2013 at. Hunting Hills in Dilliner Pennsylvania! Welcome TO THE 2013 Cabela s CLUB Family Outdoor Day on Saturday, June 1, 2013 at Hunting Hills in Dilliner Pennsylvania! Get ready for an exciting day full of outdoor activities. Cabela s staff will be

More information

SAFRA - STTA Table Tennis Championships 2018 Thursday, 8 th March Saturday, 17 th March 2018

SAFRA - STTA Table Tennis Championships 2018 Thursday, 8 th March Saturday, 17 th March 2018 Is the participant a Singapore citizen? YES NO (For examples: PR, EP, S Pass, work Permit, Student Pass, Long- Term Visit Pass etc.) Individual Category Registration Form (FOR SINGAPOREANS ONLY) [ALL FIELDS

More information

THESE FORMS ARE NOT A SUBSTITUTE FOR LEGAL ADVICE.

THESE FORMS ARE NOT A SUBSTITUTE FOR LEGAL ADVICE. DISCLAIMER The forms provided on our site were drafted by lawyers with knowledge of equine and contractual matters. However, the forms are not State specific. THESE FORMS ARE NOT A SUBSTITUTE FOR LEGAL

More information

YOUR INVITED TO TRYOUT FOR TEAM IGLOO

YOUR INVITED TO TRYOUT FOR TEAM IGLOO YOUR INVITED TO TRYOUT FOR TEAM IGLOO Team Igloo Information Highlights 2 ELITE TRAVEL TEAMS 3 rd Grade Boys Team 4 th Grade Boys Team EQUIPMENT AND COST HIGHLIGHTS 100% of the funds collected goes to

More information

Nova Scotia Lifesaving Sport Competition and Junior Lifeguard Games. Saturday, January 13, 2018

Nova Scotia Lifesaving Sport Competition and Junior Lifeguard Games. Saturday, January 13, 2018 Nova Scotia Lifesaving Sport Competition and Junior Lifeguard Games DATE LOCATION Saturday, January 13, 2018 Saturday, December 13, 2018 5:00pm 9:00pm Wilson Aquatic Centre, Rath Eastlink Truro www.ratheastlinkcommunitycentre.ca

More information

2015 AZTEC RUGBY SUMMER 7 s REGISTRATION PACKET

2015 AZTEC RUGBY SUMMER 7 s REGISTRATION PACKET 2015 AZTEC RUGBY SUMMER 7 s REGISTRATION PACKET Registration for the Summer 7s rugby season is now open. The season consists of several tournaments starting on June 6 and finishing up with a grand finale

More information

receive or request a copy of all Futsal Geelong Information please

receive or request a copy of all Futsal Geelong Information please FUTSAL GEELONG 2016 (UPDATED MARCH 2016) TERMS & CONDITIONS INTRODUCTION The aim of Futsal Geelong is to provide players of all ages and abilities with an opportunity to participate in an enjoyable, inclusive,

More information

Judo Alberta present s: 16 th Annual Female Training Camp and Sleepover. Featuring special guest instructor: Bianca Ockedahl.

Judo Alberta present s: 16 th Annual Female Training Camp and Sleepover. Featuring special guest instructor: Bianca Ockedahl. Judo Alberta present s: 16 th Annual Female Training Camp and Sleepover Featuring special guest instructor: Bianca Ockedahl March 17&18, 2018 Barracuda Judo Club St. Michael s School 864 Christie Avenue

More information

Representation Contract

Representation Contract Representation Contract (Player Representation) between Full name Civil reg. no. Business address Postcode/Town/Country (hereinafter called the Players Agent) and Full name Civil reg. no. Address Postcode/Town/Country

More information

Williamstown Sailing Club Inc. NOTICE OF RACE Club Series Racing Season

Williamstown Sailing Club Inc. NOTICE OF RACE Club Series Racing Season Williamstown Sailing Club Inc. NOTICE OF RACE Club Series Racing Season 2017 2018 1. RULES 1.1 The club races will be governed by the rules as defined in The Racing Rules of Sailing (RRS), the prescriptions

More information

RED RIDER RACING PROGRAM OFF-ROAD

RED RIDER RACING PROGRAM OFF-ROAD RED RIDER RACING PROGRAM OFF-ROAD Registration Deadline: June 1 st, 2017 Eligible Riders/Models: Anyone who has purchased and owns a registered Canadian Specification model 2015/2016/2017 CRF450R, CRF450RX,

More information

APPLICATION FORM Please fill up the form in CAPITAL letters only

APPLICATION FORM Please fill up the form in CAPITAL letters only APPLICATION FORM Please fill up the form in CAPITAL letters only CHECK LIST: HAVE YOU Fully read the information? Chosen your race category (any one)? Affixed your recent passport sized photograph with

More information

K. D. WESLEY 2018 SUMMER YOUTH PROGRAM

K. D. WESLEY 2018 SUMMER YOUTH PROGRAM K. D. WESLEY 2018 SUMMER YOUTH PROGRAM ENROLLMENT PACKET & CHECKLIST ANTIOCH FELLOWSHIP MISSIONARY BAPTIST CHURCH 7550 South Hampton Road Dallas, Texas 75232 (972) 228-2420 DR. KARRY D. WESLEY, SENIOR

More information

UOG Marine Laboratory Scientific Snorkeling Policy Guide

UOG Marine Laboratory Scientific Snorkeling Policy Guide UOG Marine Laboratory Scientific Snorkeling Policy Guide 1.0 INTRODUCTION It is the intent of the University of Guam Marine Laboratory (UOGML) to maximize Scientific Snorkeling safety. Therefore no person

More information

DENVER DIVERS SNORKELING

DENVER DIVERS SNORKELING www.denverdivers.com DENVER DIVERS SNORKELING STUDENT S NAME: MALE FEMALE DOB: MINOR* (AGE: ) ADDRESS: CITY: _ STATE: ZIP: TELEPHONE: HOME WORK MOBILE E-MAIL: * Children under 12 years old, Parent/Legal

More information

2016 Judo Alberta Provincial Judo Championships

2016 Judo Alberta Provincial Judo Championships 2016 Judo Alberta Provincial Judo Championships January 30, 2016 SANCTION #2016-04 Hosted by 2016 Judo Alberta Provincial Judo Championships January 30, 2016 8:30 am Kata 9:30 am Opening ceremonies: competitors

More information

2005 POLARIS ATV CONTINGENCY PROGRAM

2005 POLARIS ATV CONTINGENCY PROGRAM 2005 POLARIS ATV CONTINGENCY PROGRAM Welcome to the Polaris ATV Contingency Program. For 2005 Polaris is offering an industry leading contingency program for all adult and youth GNCC classes. This program

More information

1.1 All abseil bookings are sold subject to these terms and conditions.

1.1 All abseil bookings are sold subject to these terms and conditions. Terms & Conditions Spinnaker Tower Abseiling experience: 1.1 All abseil bookings are sold subject to these terms and conditions. 1.2 All bookings are identified with a unique reference number which must

More information

Morgan Memorial Goodwill Industries Running for Great Kids 2017 Falmouth Road Race Team Application

Morgan Memorial Goodwill Industries Running for Great Kids 2017 Falmouth Road Race Team Application 1 Morgan Memorial Goodwill Industries Running for Great Kids 2017 Falmouth Road Race Team Application Applications will be accepted on a rolling basis. Send completed applications to: Hilary Thomas Senior

More information

Mail applications to: Richard Imamura 602 W. Princeton Fresno, CA 93705

Mail applications to: Richard Imamura 602 W. Princeton Fresno, CA 93705 2016 Haruo Imamura College Cup HOST: Fresno Judo Club DATE: October 23, 2016 TOURNAMENT START TIME: 1:00PM LOCATION:! Washington Union High School!! 6041 S. Elm!! Fresno/Easton, CA 93706!!!!!! SANCTION:

More information

Fleet: Gold Sailor's Name Position/Division Grad Year Birthdate

Fleet: Gold Sailor's Name Position/Division Grad Year Birthdate 2012 HYSA Hawaii IMU Invitational Regatta Hawaii Youth Sailing Association, Kaneohe Yacht Club and University of Hawaii Sailing Center November 24-25, 2012 ENTRY FORM DUE BY 9:00 PM Thursday November 15,

More information

2016 ASK SUMMER CAMP ENROLLMENT FORM

2016 ASK SUMMER CAMP ENROLLMENT FORM 2016 ASK SUMMER CAMP ENROLLMENT FORM SECTION 1: STUDENT INFORMATION Registration Date: / / Name DOB / / Age Address City State Zip Code School Attending Next Year Grade Next School Year Name of Sibling(s)

More information

Midwest Cheer Elite- Cleveland All-Star Full Travel Cheerleading, Contemporary, Hip Hop & Pom

Midwest Cheer Elite- Cleveland All-Star Full Travel Cheerleading, Contemporary, Hip Hop & Pom Midwest Cheer Elite- Cleveland All-Star Full Travel Cheerleading, Contemporary, Hip Hop & Pom 2018--2019 Welcome to Midwest Cheer Elite Cleveland. We are delighted that you have chosen to become a part

More information

CANOEKAYAK CANADA ATHLETE AGREEMENT

CANOEKAYAK CANADA ATHLETE AGREEMENT CANOEKAYAK CANADA ATHLETE AGREEMENT BETWEEN: CANOEKAYAK CANADA ( CKC ) and ( Athlete ) WHEREAS CKC is recognized by the International Canoe Federation (ICF) and the Government of Canada as the sole governing

More information

Open to all Tai Chi enthusiasts

Open to all Tai Chi enthusiasts Open to all Tai Chi enthusiasts 2nd June 2018 (SATURDAY) 9.00am to 5.00pm SYDNEY UNIVERSITY SPORTS & AQUATIC CENTRE Darlington Road, DARLINGTON, NSW 2008 Registration Closing Date: 6 th May 2018 (SUNDAY)

More information

SCUBA DIVING SAFETY MANUAL

SCUBA DIVING SAFETY MANUAL SCUBA DIVING SAFETY MANUAL Revised: 11 July 2017 TABLE OF CONTENTS Preamble... 3 Disclaimer... 3 Abbreviations... 3 Definitions... 3 General Requirements... 4 Additions... 4 CAUS 3.1 Organization Requirements....

More information

2016 TCS New York City Marathon Wediko Team Application

2016 TCS New York City Marathon Wediko Team Application 2016 TCS New York City Marathon Wediko Team Application Running the TCS NYC Marathon there s nothing quite like it. The five boroughs, the cheering crowd, finishing in Central Park. Glad you are considering

More information

DENVILLE RECREATION 2014 SKI & SNOWBOARD PROGRAM

DENVILLE RECREATION 2014 SKI & SNOWBOARD PROGRAM Registration for the Denville Recreation Ski and Snowboard Program is now open. The bottom of this form should be completed for each participant and returned to Don Bogardus, Denville s Recreation Director,

More information

Top End Motocross Club, Kununurra MX Club and Katherine Off Road Motorcycle Sports club Present the MX Tri-Series SUPPLEMENTARY REGULATIONS

Top End Motocross Club, Kununurra MX Club and Katherine Off Road Motorcycle Sports club Present the MX Tri-Series SUPPLEMENTARY REGULATIONS Top End Motocross Club, Kununurra MX Club and Katherine Off Road Motorcycle Sports club Present the 2016 MX Tri-Series SUPPLEMENTARY REGULATIONS Important Information: Rd Date Club Venue Track Licence

More information

2016 POLARIS ATV and ACE NEW RACER REIMBURSEMENT PROGRAM

2016 POLARIS ATV and ACE NEW RACER REIMBURSEMENT PROGRAM 2016 POLARIS ATV and ACE NEW RACER REIMBURSEMENT PROGRAM Thank you for your interest in racing Polaris ATVs and ACE. This program was created to provide first-time racers the ability to collect a Reimbursement

More information

RPI s Annual Spring Judo Tournament

RPI s Annual Spring Judo Tournament Hosted by: RPI Judo Club Sanctioned by: United States Judo Association 10-028 Date: Saturday, April 30th, 2011 RPI s Annual Spring Judo Tournament Location: Registration: Eligibility: Entry Fee: Late Fee:

More information

Midwest Cheer Elite Limited Travel Cheerleading Teams

Midwest Cheer Elite Limited Travel Cheerleading Teams Midwest Cheer Elite Limited Travel Cheerleading Teams Welcome to Midwest Cheer Elite, Inc. We are delighted that you have chosen to become a part of one of the top All-Star programs in the Midwest! Our

More information

SUPPLEMENTARY REGULATIONS

SUPPLEMENTARY REGULATIONS ALICE SPRINGS MOTORCYCLE CLUB INC WILL CONDUCT THE JJ Richards & Sons MOTOCROSS SERIES www.asmcc.com.au SUPPLEMENTARY REGULATIONS MEETING NAME VENUE DATE ROUND 1 MOTOCROSS OF SERIES OF 3 BUTLER ROAD ILPARPA

More information

Bodybuilding, Figure, Bikini and Physique Championships - Featuring Men s Pro Level 2 and Figure Pro Classic Physique & Classic Bikini

Bodybuilding, Figure, Bikini and Physique Championships - Featuring Men s Pro Level 2 and Figure Pro Classic Physique & Classic Bikini ANBF Sanctioned 2017 POCONO CLASSIC APRIL 22, 2017 Lakeland Junior Senior High School 1355 Lakeland Drive, Jermyn PA 18433 Bodybuilding, Figure, Bikini and Physique Championships - Featuring Men s Pro

More information

1. BREEDER: Equine Breeding Agreement

1. BREEDER: Equine Breeding Agreement Equine Breeding Agreement This Equine Breeding Agreement (the Agreement ) is entered into as of by and between Hilltop Farm, Inc., a Maryland corporation with its principal place of business at 1089 Nesbitt

More information

2017 Texas Judo Inc. NCJA Southwest Regional Collegiate Championships

2017 Texas Judo Inc. NCJA Southwest Regional Collegiate Championships HOST: Texas A&M University Judo Team DATE: Sunday, February 19, 2017 LOCATION: Physical Education Activity Building (PEAP) 632 Penberthy Road Texas A&M University - College Station, Texas, 77843 SANCTION:

More information

5901 Mt. Gainor Rd Wimberley, Tx HUNT AGREEMENT AND LIABILITY RELEASE

5901 Mt. Gainor Rd Wimberley, Tx HUNT AGREEMENT AND LIABILITY RELEASE HUNT AGREEMENT AND LIABILITY RELEASE This agreement is made by DOUBLE F RANCH hereinafter referred to as the OUTFITTER and (NAME, ADDRESS AND PHONE NUMBER) hereinafter referred to as the CLIENT. This agreement

More information

BOWLS NEW ZEALAND NATIONAL MIXED PAIRS CHAMPIONSHIP

BOWLS NEW ZEALAND NATIONAL MIXED PAIRS CHAMPIONSHIP BOWLS NEW ZEALAND NATIONAL 2-4-2 MIXED PAIRS CHAMPIONSHIP Conditions of Play for Regional Playoffs (2018) BOWLS NEW ZEALAND - CONDITIONS OF PLAY REGIONAL PLAYOFFS NATIONAL 2-4-2 MIXED PAIRS CHAMPIONSHIP

More information

PAVILION RENTAL FEE & GENERAL INFORMATION

PAVILION RENTAL FEE & GENERAL INFORMATION PAVILION RENTAL FEE & GENERAL INFORMATION EFFECTIVE JANUARY 1, 2018 710 Western Ave. Geneva, IL 60134 630-232-4542 - phone 630-232-4569 - fax info@genevaparks.com -email Wheeler Park South Pavilion and

More information

To All SAMBO Enthusiasts

To All SAMBO Enthusiasts AASF EXECUTIVE COUNCIL BOARD MEMBERS To All SAMBO Enthusiasts Dr. J. KOGAN Acting - President Mr. V. ZASLAVSKY Acting - Secretary General Chairman of Referee Committee Mr. V. TATARKIN - NY State President

More information

Killarney Swimming Club

Killarney Swimming Club Killarney Swimming Club MEMBERSHIP CONSENT FORM To be completed by parents/guardians of all swimmers under 18 and by all swimmers 18 & over Athletes Name : Date of Birth: Address: Email: Parent s work

More information

Tennessee District 2018 RAW POW WOW JUNE 2018 REGISTRATION FORM - OUTPOST OUTPOST INFORMATION. Street address: Outpost Number Date / /

Tennessee District 2018 RAW POW WOW JUNE 2018 REGISTRATION FORM - OUTPOST OUTPOST INFORMATION. Street address: Outpost Number Date / / Tennessee District 2018 RAW POW WOW 21 23 JUNE 2018 REGISTRATION FORM - OUTPOST Balance Due: Date Received Amount Received: OUTPOST INFORMATION Church Name: Chartered: Yes No Age Group (Please Circle)

More information

Application for ADULT AND JUNIOR Competition Licence If you made payment online, please enter your address used here:

Application for ADULT AND JUNIOR Competition Licence If you made payment online, please enter your  address used here: Motorcycle Union of Ireland (Southern Centre) Ltd t/a Motorcycling Ireland Ltd Unit 18 the Beat Centre, Balbriggan Co Dublin Phone: 01 8020480 Email: nikki@motorcycling-ireland.com Website:www.motorcycling-ireland.com

More information

KATSUTA KUP JUDO CHAMPIONSHIP

KATSUTA KUP JUDO CHAMPIONSHIP KATSUTA KUP JUDO CHAMPIONSHIP Judo Alberta Sanction #2015-07 DATE: SATURDAY, April 18, 2015 PLACE: Raymond High School 65W - 100N TIME: 10:00 AM WEIGH INS: Fri. April 17, 6:45-8:00 PM Jr. High Sat. April

More information

WOODSIDE PONY CLUB CLASSIC COMBINED TEST

WOODSIDE PONY CLUB CLASSIC COMBINED TEST WOODSIDE PONY CLUB CLASSIC COMBINED TEST Sunday, September 10, 2017 The Horse Park at Woodside, 3674 Sand Hill Road, Woodside, CA (1/2 mile west of Hwy 280) DIVISIONS: Classes will be run starting with

More information

BOWLS NEW ZEALAND NATIONAL CLUB CHAMPIONSHIP SINGLES, PAIRS, TRIPLES AND FOURS

BOWLS NEW ZEALAND NATIONAL CLUB CHAMPIONSHIP SINGLES, PAIRS, TRIPLES AND FOURS BOWLS NEW ZEALAND NATIONAL CLUB CHAMPIONSHIP SINGLES, PAIRS, TRIPLES AND FOURS Conditions of Play for Regional Playoffs (2018) BOWLS NEW ZEALAND - CONDITIONS OF PLAY REGIONAL PLAYOFFS NATIONAL CLUB CHAMPIONSHIP

More information

Upper St. Clair Hockey Association

Upper St. Clair Hockey Association Upper St. Clair Hockey Association Dear Hockey Family, It s time to prepare for the 2014-2015 high school hockey season. The Upper St. Clair Hockey Association (USCHA) is now registering players in 7 th

More information

JUDO CHAMPIONSHIP DALLAS INVITATIONAL. November 22, th Annual USA JUDO SENIOR D LEVEL & JUNIOR C LEVEL TOURNAMENT HOTEL NAME COMPETITION VENUE

JUDO CHAMPIONSHIP DALLAS INVITATIONAL. November 22, th Annual USA JUDO SENIOR D LEVEL & JUNIOR C LEVEL TOURNAMENT HOTEL NAME COMPETITION VENUE 49th Annual DALLAS INVITATIONAL JUDO CHAMPIONSHIP $1,000 1st Place $300 2nd Place $200 3rd Place USA JUDO SENIOR D LEVEL & JUNIOR C LEVEL TOURNAMENT HOTEL NAME Marriott Las Colinas 223 W. Las Colinas Blvd

More information

Stephen F. Austin State University Dance Teams Dance Workshop Wednesday, November 16, 2011 Baker Patillo Student Center SFA Campus

Stephen F. Austin State University Dance Teams Dance Workshop Wednesday, November 16, 2011 Baker Patillo Student Center SFA Campus Stephen F. Austin State University Dance Teams Dance Workshop Wednesday, November 16, 2011 Baker Patillo Student Center SFA Campus General Information: - The cost for the workshop is $20.00 per dancer

More information

Junior Participating in Adult Roller Derby Division Check List

Junior Participating in Adult Roller Derby Division Check List Junior Participating in Adult Roller Derby Division Check List Junior s Name: Parents /Legal Guardian Names: Name of Club Accepting Junior & Club Id: The following items must be returned together to the

More information

Please note: Campers with incomplete/missing forms will not be allowed to participate in REC Kids Camp. You do not need to submit this page.

Please note: Campers with incomplete/missing forms will not be allowed to participate in REC Kids Camp. You do not need to submit this page. Form Instructions Thank you for signing up for REC Kids Camp! The following pages are all required. Please read through carefully, as all areas of each form must be filled out in order be considered complete.

More information

62nd Annual Obukan Judo Shiai and Kata / Onchi Sensei Memorial Tournament Sponsored by Obukan Judo Dojo, Inc. Sanctioned by the USJF (# )

62nd Annual Obukan Judo Shiai and Kata / Onchi Sensei Memorial Tournament Sponsored by Obukan Judo Dojo, Inc. Sanctioned by the USJF (# ) 62nd Annual Obukan Judo Shiai and Kata / Onchi Sensei Memorial Tournament Sponsored by Obukan Judo Dojo, Inc. Sanctioned by the USJF (#18-03-11) Tournament date: Kata: Friday, March 23, 2018 Shiai: Saturday,

More information

Invitation to express interest UEFA Club Competitions Accommodation Agency - Cycle

Invitation to express interest UEFA Club Competitions Accommodation Agency - Cycle Invitation to express interest UEFA Club Competitions Accommodation Agency - Cycle 2018-2021 1. Introduction UEFA wishes to select one or several company(ies) in charge of sourcing, contracting & managing

More information

2017 AMERICAN MASTERS WEIGHTLIFTING CHAMPIONSHIPS NOVEMBER 9-12, 2017 SAVANNAH, GEORGIA, USA

2017 AMERICAN MASTERS WEIGHTLIFTING CHAMPIONSHIPS NOVEMBER 9-12, 2017 SAVANNAH, GEORGIA, USA Presented by Team Savannah Weightlifting, Inc. Competition Venue Entry Fees Mail to Paul Anderson / Howard Cohen Weightlifting Center 7232 Varnedoe Drive Savannah, GA 31406 Individual Early Entry Fee through

More information

2014 AUSTRALIAN OLYMPIC WINTER TEAM Ski & Snowboard Australia NOMINATION CRITERIA ALPINE SKIING

2014 AUSTRALIAN OLYMPIC WINTER TEAM Ski & Snowboard Australia NOMINATION CRITERIA ALPINE SKIING 2014 AUSTRALIAN OLYMPIC WINTER TEAM Ski & Snowboard Australia NOMINATION CRITERIA ALPINE SKIING NOTE: The AOC reserves the right to require amendments to the Nomination Criteria and amend its Selection

More information

MANCHESTER CITY FC AWAY TICKET TERMS AND CONDITIONS 2017/18. Please read this document carefully as the terms below apply to your use of a Ticket.

MANCHESTER CITY FC AWAY TICKET TERMS AND CONDITIONS 2017/18. Please read this document carefully as the terms below apply to your use of a Ticket. MANCHESTER CITY FC AWAY TICKET TERMS AND CONDITIONS 2017/18 Please read this document carefully as the terms below apply to your use of a Ticket. In particular, we ask you to note the following: - The

More information

Obukan Judo Dojo Inc.

Obukan Judo Dojo Inc. 59 th Annual Obukan Judo Shiai and Kata / Onchi Sensei Memorial Tournament Sponsored by Obukan Judo Dojo, Inc. Sanctioned by the USJF (#15-04-09) Tournament date: Saturday, April 04, 2015 Eligibility:

More information

D.O.B. (day/month/year)

D.O.B. (day/month/year) Name D.O.B. (day/month/year) Mailing Address; Contact Telephone; Email address; For certifying instructor; Course Completion date (day/month/year) Instructor name and number LIABILITY RELEASE AND ASSUMPTION

More information

SWIM Across the Sound Marathon

SWIM Across the Sound Marathon St. Vincent s SWIM Across the Sound Marathon August 5 th, 2017 Captain s Cove Seaport, Bridgeport, CT TWO-PERSON RELAY APPLICATION SWIM MARATHON RULES & GUIDELINES TWO-PERSON RELAY SWIMMERS 1. PARTICIPATION:

More information

BUILDING CONFIDENCE. Swim Lessons MARY PERRY RAGSDALE FAMILY YMCA

BUILDING CONFIDENCE. Swim Lessons MARY PERRY RAGSDALE FAMILY YMCA BUILDING CONFIDENCE Swim Lessons MARY PERRY RAGSDALE FAMILY YMCA Swim Starters: Children ages 6months-3 years old (with parents) Swim Basics: Children ages 3-5 years old OR Children age 5-12 OR Teens/Adults

More information

Ft Johnson Estates Swimming Pool Club 2017 Rules, Regulations, & Liability Waiver

Ft Johnson Estates Swimming Pool Club 2017 Rules, Regulations, & Liability Waiver Ft Johnson Estates Swimming Pool Club 2017 Rules, Regulations, & Liability Waiver A. MEMBERS AND GUESTS SWIM AT THEIR OWN RISK Periodically there will be an attendant at the pool, but no lifeguard on duty.

More information